Bottom Line: Implementation of a program designed to reduce hospital readmissions was associated with a reduction in the rate of readmissions, but also an increase in the rate of death among Medicare patients hospitalized with heart failure.
Why The Research Is Interesting: Heart failure is the leading cause of readmissions among Medicare patients. The Affordable Care Act of 2010 established the Hospital Readmissions Reduction Program (HRRP), which involved public reporting of hospitals' 30-day readmission rates for heart failure, heart attack, and pneumonia and created financial penalties for hospitals with higher readmissions. However, incentives to reduce readmissions can potentially encourage inappropriate care strategies and may adversely affect patient outcomes.
Who: 115,245 fee-for-service Medicare patients from 416 hospital sites
When: January 2006 through December 2014 divided into periods before (January 1, 2006 to March 31, 2010), during (April 1, 2010 to September 30, 2012) and after HRRP penalties went into effect (October 1, 2012 to December 31, 2014).
What (Study Measures): Risk of hospital readmission or death 30 days and one year after discharge.
How (Study Design): This was an observational study. In observational studies, researchers observe exposures and outcomes for patients as they occur naturally in clinical care or real life. Because researchers are not intervening for purposes of the study they cannot control natural differences that could explain study findings so they cannot prove a cause-and-effect relationship.
Authors: Gregg C. Fonarow, M.D., of the Ronald Reagan-UCLA Medical Center, Los Angeles, and Associate Editor of the Health Care Quality and Guidelines section, JAMA Cardiology, and coauthors
Study Limitations: This is an analysis of heart failure hospitalizations from hospitals participating voluntarily in a heart failure clinical registry and may not be generalizable to other hospitals. This is a patient-level analysis of readmissions and mortality and does not directly establish the association of change in readmission rate at a given hospital with change in its mortality rate.
Study Conclusions: These findings raise concerns that the HRRP, while achieving desired reductions in readmissions, may be associated with compromised survival of patients with heart failure. If the findings are confirmed they may require reconsideration of use of the HRRP penalties program for patients with heart failure.
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